Saturday, January 02, 2016

You Could…

Rocky Mountain Stroke Survivor
Posted on April 22, 2013

In the last two weeks, I’ve had several people suggest, “Now that [you’re doing so well, you’re three months out, you’re recovering], you could moonlight.”  I’m sure they mean well.

I think the first confusion is that for people who have not suffered a major medical set-back, the tendency is to equate HAPPY with BEING WELL.  The thing is, I’ve had a stroke.  Back before, if I felt like crap, I could go ahead and let it affect my mood.  I tried not to but if I had a migraine or a sinus infection, even if I wasn’t downright pissy, I was definitely subdued.  Having a stroke is a long term state of being.  I can’t base my cheerfulness, enthusiasm for life, or how chatty I am on how I’m doing.  I still feel low emotionally at night when I’m completely wiped out and at the end of the week for the same reason, but in general, how I feel physically has been taken out of the equation to determine how I feel emotionally.  I think those around me can see me smiling and chatting and clearly HAPPY and they are relieved to think that I am DOING WELL.

I think the next confusion is that people who know me want to believe that I am getting back to my old self.  They don’t want to believe that I could have been permanently affected.  It’s hard for them to embrace the new me because they are still mourning the loss of the old me.  They say that the stages of grief can be easily understood when compared to the “grief” you have when your car won’t start in the morning.  What’s the first thing you do?  You keep turning the key over and over as if it’s going to suddenly start…that’s the disbelief stage.  I think many of my friends and family are still in the disbelief stage.  [Quick note: the stages of grief are not necessarily “completed” or moved through in a particular order.  A lot of people fluctuate between them.]

I have realized that another confusion is that people see me making progress and they think I am making progress on the path back to the old me when in reality I am moving along the path to the best version of the new me.  Anyone who has dealt intimately with stroke will tell you that the survivor is never exactly the same again.  Those who know me best are able to see the new me emerging and are nice enough to just work around any problems and not mention them unless I bring it up.  I am no longer focused on trying to go back.  I’m going forward.  That new me may be very similar to the old me or may be very different, but that’s the way I’m headed now.

Finally, I suspect the issue that seals the confusion is one common to all doctors…people who have never worked in medicine don’t have a clear understanding of  what goes in to doctoring.  We all agree we want a doctor who is smart, caring, listens well, doesn’t miss any diagnostic possibilities but doesn’t run any unnecessary tests, answers our phone calls promptly, and who is usually on time.  What is not always obvious is how much running around goes on in the background to make that happen.

In my previous life, on a typical day, I’d be seeing multiple patients in an hour, have at least two rooms going at the same time, be taking and making phone calls with other doctors, answering messages from patients, returning patient phone calls, reviewing labs and imaging and making clinical decisions.  I had about 1000 patients in my “panel” plus I would cover for other physicians in my practice who were not in that day.  To be totally honest, when doctors look like they are listening for several minutes in a row, they are often reviewing results, looking up clinical conundrums on doctor-oriented websites, or puzzling over everything they must consider for your clinical situation.  Part of the brain is listening and part of the brain is working in six directions trying to figure out the best course for you.  Add in text messages coming up from the medical assistant and the possibility that they received some urgent results for another patient during your appointment that they are trying to deal with discretely without missing what you are saying.  And then there are the numerous interruptions during the day when another doctor calls or the triage nurse has a question that can’t wait.  At the end of the day, I’d go home with an hour or more of work left to do…patient appointments to document, messages to reply to, results to review and notify patients about.  Contrary to what you might think, EMRs (electronic medical records) have greatly increased the amount of work most doctors have to do.  The big benefit in work flow is that you aren’t carting a trunk full of charts home with you at the end of the day.  I am cognitively intact and even last night was told by another physician, “You are obviously as sharp as ever,” which sounds condescending on paper but made me feel great.  But my brain just can’t handle the chaos of a normal practice.

Moonlighting is worse because moonlighting typically means taking shifts in an urgent care.  I would be working with multiple different assistants (which means there wouldn’t be just one who knew me and could work with me like a well-choreographed dance).  I would be seeing every person who came through the door…so there’s no way to limit my schedule.  I would have to puzzle out each patient completely fresh and new.  My brain really can’t handle that level of chaos and effort right now.

With all of the above taken into consideration, even though my current practice may seem like too little to other people, for me it’s just right.  I have lots of time for therapy and sleep.  I only work for a couple hours a day.  I see one person at a time and have a full hour with them so don’t have to try to juggle or rush.  I have a panel of a couple hundred rather than 1000 and they contact me directly so I’m not dealing with messages swarming between me and various staff.  I know every patient extremely well so I don’t have to read back through the chart to figure out what’s going on.  I have open access scheduling (catch phrase for “you don’t have to schedule 3 months out to get an appointment”), which not only benefits the patients, but it means that I can change my schedule easily if need be.  With a week’s notice I don’t even have to reschedule anyone.  If something comes up suddenly (such as a trip to the ER), I only have a couple people to reschedule.  If someone needs something urgently and I don’t feel good, I can ask them to stop by my house (which is only 3 blocks from my office).  I still feel crappy from any car ride/drive but 3 blocks barely adds a half a strokey point.  If I foresee an otherwise busy day, I can block my appointments and not see anyone.

It’s hard for many people to learn to set limits.  My previous tendency was to think that if anyone said I “could” do something that I therefore should.  I’ve learned otherwise, but it hasn’t been easy.

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